Sunday, April 25, 2010

Although agency policies on medical benefits are similar, GAO found some issues with medical care following deployment and post deployment medical screenings. Specifically, while DOD allows its treatment facilities to care for non-DOD civilians after deployment in some cases, the circumstances are not clearly defined and some agencies were unaware of DOD’s policy. Further, while DOD requires medical screening of civilians before and following deployment, State requires screenings only before deployment. Prior GAO work found that documenting the medical condition of deployed personnel before and following deployment was critical to identifying conditions that may have resulted from deployment. GAO recommended, among other things, that State establish post-deployment screening requirements and that DOD establish procedures to ensure its post-deployment screening requirements are completed. While DOD and State agreed, DOD has developed guidance establishing procedures for post-deployment screenings; but, as of April 2010, State had not provided documentation that it established such requirements.

Ambassador Patrick Kennedy who is the State Department's Under Secretary for Management was one of the witnesses in the Deployed Federal Civilian hearing on April 14. Note that he made mention of the High Stress Outbrief Program but made no mention of post deployment medical screenings recommended by the GAO. Really, the briefing is great, medals are welcomed, I'm sure, handbooks are helpful, but the post deployment medical screening for deployed personnel is actually more important. Why is State not doing that? We've been in this warzones exactly seven years going on eight in Iraq and nine years this October in Afghanistan. You'd think that the smart folks would figure this out by now.

Okay, okay, we now know that there are no/no WMDs in Iraq, yok, nada -- and we might be tempted to say that well -- there are no harmful exposure over there. But, you've heard about those burn pits, right? This report from Navy Times says that "A 2008 study that fine particulate matter at Balad and 14 other deployment sites is well above both World Health Organization and U.S. military standards." The Senate Democratice Policy Committe even had a hearing on burn pits and this testimony from a VA doctor testifying in his own personal capacity is worth reading. He said in part that "Inhalation of PM [particulate matters] air pollution can lead to premature death from respiratory and cardiovascular causes, including strokes. Inflammation and reduced lung function may even be seen in lung tissue from healthy adults. Year-round exposure to PM has been associated with small airway disease and increased risk of dying from lung cancer and cardiovascular disease." Also see this one on toxins in Iraq and Afghanistan. Big yikes!

On additional work hours, Ambassador Kennedy also had this to say: "employees receive overtime, or a comparable payment, to compensate for the long hours that extend the work week far beyond 40 hours." Pray tell, what does "comparable payment" actually means in simple English? Is that comp time? Or something else? Remember that the US Embassy Kabul staff are reportedly working 80 hour workweeks. If employees get comp time instead of overtime, does that mean 40 hour comp time a week for a year? How do you actually spend that? Just asking...

In any case, if you've been to the warzones and were ever extended post deployment medical screening by MED, would you let us know? Curious minds would like to know; although we can't really imagine why State would not tell GAO if the program already exists. Excerpt below from Ambassador Kennedy's testimony:

DEPLOYMENT INCENTIVES AND PROGRAMS
Our missions in Afghanistan and Iraq always have been fully staffed with volunteers. In turn, the Department has focused on ensuring that these volunteers are prepared, trained, compensated and supported before, during and after their assignments. In recognition of the personal risk and hardship to our employees, we have strengthened the compensation and benefit package received when serving in Iraq and Afghanistan.

These employees receive a compensation package of incentives and benefits comprised of the following. All receive the maximum hardship differential and danger pay allowance allowed by law, totaling an additional 70% of an employee’s basic pay. With the exception of political appointees, Senior Foreign Service, and the Senior Executive Service, employees receive overtime, or a comparable payment, to compensate for the long hours that extend the work week far beyond 40 hours. Employees also are offered several Rest and Recuperation (R&R) trips during their one-year tours and can choose to return to the U.S. or take R&R within the region. We offer administrative leave to facilitate the employee’s ability to actually take these R&R trips. And we supported legislation that increased the annual premium pay cap to equal the Vice President’s salary and eliminated the aggregate pay cap for eligible employees serving in Iraq and Afghanistan.

We also established certain incentives specific to the Foreign Service. For example, Selection Boards are reminded that as they consider those eligible for promotion, they recognize that service at posts, like Iraq and Afghanistan, is done under exceptionally challenging circumstances in fulfillment of our foreign policy priorities. Moreover, support for our employees and their families during and after their assignments is critical. With 18 posts around the world designated by the State Department as ―unaccompanied or ―partially unaccompanied posts, we realized the importance of addressing the challenges invariably faced when families are separated for extended periods. Our Family Liaison Office (FLO) addresses these specific challenges. For example, we have established two positions in that office dedicated solely to working with the families of employees serving on an unaccompanied tour. These professionals provide the families with a single point of contact for information, referrals, emotional support, and assistance through personal consultations, e-mails, newsletters, phone calls, print and online publications, and group briefings. The Department also contracted with MHN (formerly Managed Health Network) to provide 24/7 access to a customized Web portal, telephone hotline, and face-to-face counseling sessions with a clinician for any family members residing outside the Washington, D.C. area. In addition, to address the unique needs of children with deployed parents, we developed individualized, age-appropriate handbooks to help State Department children understand and cope with the stress of having a parent serving on an unaccompanied tour. The Department recognizes the sacrifices of these children and therefore created a special ―medal that is presented to each child along with a certificate of recognition.

REQUISITE TRAINING AND MEDICAL SUPPORT FOR WORKING IN THE HIGH STRESS ENVIRONMENTS
Training is a prerequisite for all employees serving overseas. Through training offered at the Department’s National Foreign Affairs Training Center and elsewhere, we ensure that our employees have the cultural awareness and necessary knowledge to perform in all overseas environments. In particular, we emphasize this training requirement for civilians serving in combat zones. The existing mandatory training for all U.S. government civilians assigned to Afghanistan is extensive. In addition to a one-week mandatory security training course, we provide a one-week Afghanistan Familiarization course for all Federal government civilians from 10 agencies assigned to Afghanistan. All civilians who will work outside Kabul in the provinces, districts, or regional platforms, and those who will support them from our embassy in Kabul, are required to take two additional weeks of training, a field-work focused "Provincial Reconstruction Team Orientation" course for all civilians plus integrated civilian-military field training at the the Department of Defense’s Muscatatuck Urban Training Center in Indiana. This integrated civilian-military training ensures that civilians are prepared to work with their military counterparts in Afghanistan from the first day they arrive in-country. And, training waivers are rare.

Civilians serving in combat zones are exposed to stress levels comparable, at times, to those experienced by military personnel. To facilitate the capacity of our employees to recognize and handle the inherent stress of working in these types of environments, all employees assigned to Afghanistan and Iraq attend mandatory pre-departure sessions designed specifically to familiarize them with security issues unique to combat zone assignments, alert them to the causes and the signs of stress-related conditions, and provide them with techniques for managing the stress of being in a combat zone. In addition, they receive information about resources available that can provide needed support and assistance while they are in the field. Following any high stress assignment—including, but not limited to, those in Afghanistan and Iraq — our training operation, supported by the Office of Medical Services, conducts a mandatory ―High Stress Outbrief‖ program intended specifically to assist employees in recognizing Post Traumatic Stress Disorder (PTSD). Employees who cannot attend the course in Washington, can arrange to receive this outbrief through our health units at our Embassies abroad. We also offers over an INTRANET links a distance learning course to help those who are managing employees who previously worked at high-stress posts.

Recognizing the need for additional support services, the Office of Medical Services (MED) established a Deployment Stress Management Program (DSMP) with a board-certified psychiatrist serving as the Director supported by two social workers. It provides information, referrals, initial assessment, and brief treatment for all stress-related problems, including PTSD. It also provides resiliency training as an important element of our overall training for all deploying civilians under the Ambassador’s authority. This medical support unit is not working alone. Additional mental health practitioners are assigned to the Health Units in Kabul and Baghdad and supported by our regional psychiatrists in Amman, New Delhi, and Washington, D.C. They are tasked to provide strategies for stress management, PTSD screening, and initial treatment for all personnel under the Ambassador.

Employees who are identified as possibly suffering from stress-related disorders and who require treatment that is not locally available can return to Washington, D.C. for a six- to seven-week program of treatment. The goal of this program is to enable the majority of participants to return to full-duty and so far all five employees treated within the program have returned to work. Employees who incur work-related medical conditions are eligible for a wide variety of benefits under the Federal Employees' Compensation Act, including medical and wage loss benefits. To facilitate continued monitoring, there is a follow-up PTSD screening initiative for Department of State employees who have served in combat zones since 2002 and we are in the process of establishing a personnel tracking mechanism for civilians deployed to Iraq and/or Afghanistan.

Talk to AFSA. Talk to your congressional representatives. We need to get that post-deployment medical screening in place. I don't think calling for this makes me a red-haired child running around with my hair on fire -- um, okay you can call me that, too. But what if you or your spouse/partner develop severe respiratory problems 2-3 years after service in the warzones. How would you know where you pick that up? Or know for sure, that these two are related? "Health is wealth" -- except that we do not fully recognize this until we're in poor health.